Healthcare Provider Details

I. General information

NPI: 1184939787
Provider Name (Legal Business Name): YUSUF S. RUHULLAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 HARRISON ST STE 247
HILLSIDE IL
60162-1919
US

IV. Provider business mailing address

4415 HARRISON ST STE 247
HILLSIDE IL
60162-1919
US

V. Phone/Fax

Practice location:
  • Phone: 312-738-3355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9073A
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.175019
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: